Supervisor, Claims

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

Job Summary

The supervisor provides direct oversight by supervising the day-to-day operations of all aspects of claims processing. This position provides training and coaching both on the group and individual levels, noting achievements and progress when completing individual performance evaluations as well as addressing taking disciplinary actions if necessary.

Key Responsibilities/Duties – what you will be doing

• Oversee day-to-day operations and the assignment and distribution of work to ensure that all claims are processed within the required time limits. Maintains the flow and processing of information within the Claims department to ensure turnaround times are achieved. Ensures that mandatory requirements, as set by regulatory bodies, are achieved.

• Establishes, builds, and maintains positive working relationships to ensure that all data is processed according to policy. Continually monitor reports and communication on regular basis.

• Participates in the development, implementation and improvement of departmental policies and procedures. Develops, monitors, and adjusts as necessary quality processes to provide performance measurement standards for individuals and the department.

• Provides feedback and coaching via regular one-on-one meetings. Conducts formal performance appraisals and appropriate disciplinary action in a timely manner as well as in accordance with NH Human Resources policies and procedures.

• Maintains a thorough understanding of claims processing. Conducts initial and ongoing education and training on Network Health policies/procedures and programs to ensure standardized approach to processing requests among team members. Updates staff on new developments in work processes and provider issues.

• Provides support to staff by researching, resolving, and collaborating with key stakeholders to solve complex and urgent issues. Ensures that appropriate person/department from across the organization is consulted on applicable issues.

• Manages and monitors of metric (software) to ensure adequate coverage and timely responses on an ongoing basis. Reviews and generate productivity reports on a weekly and monthly basis.

• Acts as the initial contact for the department for issues and delegates accordingly.

• Participates in departmental and interdepartmental meetings as appropriate and necessary.

• Participates in ad hoc projects, as necessary.

• Maintains professional growth and development through self-directed learning activities.

• Encourage a high work ethic within staff by demonstrating appropriate and acceptable management skills.

• Encourages and precipitates a collaborative work environment among team members.
• Other duties and projects as assigned

Qualifications – what you need to perform the job

• An in-depth understanding of Coordination of Benefits (COB) rules to ensure accurate coordination of benefits.
• Proficiency in handling Third Party Liability (TPL) claims and other Insurance policies including subrogation and recovery processes.
• Understanding of Federal, State, and industry-specific regulations and guidelines related to COB and TPL claims.
• A comprehensive understanding of healthcare, including HIPAA, Medicare, and Medicaid guidelines, in COB, MSP and TPL processes

Compensation & Total Rewards Overview

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

​Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent.  We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

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